A Crash Course in Motivational Interviewing

Out of the Fish BowlFor social workers who work in addictions, motivational interviewing has become the treatment of choice for working with populations in recovery or living with substance use.

Motivational interviewing, pioneered by psychologist William R. Millner, Ph.D., and professor Stephen R. Rollnick, Ph.D., also has common ties with Carl Rogers’ person-centered therapy and social work values.  Clients are assumed inherently capable and desiring of self-actualization (fancy term for being your best self), clients are met where they are at, active listening is viewed as an active tool and not just a passive intervention, and client’s self-determination is honored as a core value.  Self-determination is the core value of MI because motivational interviewing must be sincere, transparent, and not come from a manipulative place.

So, why learn about motivational interviewing?  Well, other than statistics supporting the high (30% to 50%) comorbidity of mental illness and substance abuse (NAMI, 2013), motivational interviewing can be utilized for an array of client problems beyond substance abuse.  It does this because it helps the practitioner empathize with and utilize the resistance and ambivalence always present in the dynamics of change.

Also, when it comes to treatment, motivational interviewing, in many ways mirrors the stages of therapy, from engagement to termination.  Let’s take a quick look at the “skeleton” of MI treatment’s stages of change:

Precontemplation (Usually the engagement stage):  Client does not think substance use or issue x is a problem.  The engagement phase will involve “rolling with the resistance” (Motivational Interviewing Organization, 2014) and validating the adaptive function the behavior is serving despite the adverse consequences.

Contemplation:  Client feels substance use or x is a problem, but is ambivalent about changing, or is closer to wanting change.

Preparation:  Client verbalizes motivation for change.  Practitioner will collaborate with client to find resources and plan for change (seek referrals, connect to resources, etc.)

Action:  Treatment is more active, client is started on medication/groups/self-help meetings, and momentum is gained in the treatment.

Maintenance:  Recovery is recognized as a phenomenon that goes far beyond abstinence (Columbia Center for Practice Innovations, 2014) and go into effecting change in other life areas to prevent relapse and create a more satisfying life.

Whether people are trying to change a destructive habit, or making a positive change (even if it’s giving up cupcakes…which is hard in NYC), change is hard for all of us.  MI validates change as a process rather than a single event.

Onward and out of the fish bowl of stagnation.

External Resources and References:

Motivational Interviewing Basics –  An Overview from the MI Training Organization.

Center for Practice Innovations – Columbia University’s Focus on Integrated Treatment (FIT) Training, which includes motivational interviewing modules.

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